(1) On or after July 1, 2002, it is unlawful for any person, partnership, association, or corporation to conduct or maintain an assisted living residence without having obtained a license therefor from the department of public health and environment. Any person who violates this provision:
(a) Commits a civil infraction;
(b) May be subject to a civil penalty assessed by the department of not less than fifty dollars nor more than one hundred dollars for each day the residence violates this section. The assessed penalty shall accrue from the date the residence is found by the department to be in violation of this section. The assessment, enforcement, and collection of the penalty shall be by the department in accordance with article 4 of title 24, C.R.S., for credit to the assisted living residence cash fund created pursuant to section 25-27-107.5. Enforcement and collection of the penalty shall occur following the decision reached in accordance with procedures set forth in section 24-4-105, C.R.S.
Source: L. 84: Entire article added, p. 790, � 1, effective July 1. L. 85: Entire section R&RE, p. 925, � 3, effective July 1. L. 90: Entire section amended, p. 1354, � 2, effective July 1. L. 94: IP(1) amended, p. 2795, � 543, effective July 1. L. 2002: IP(1) and (1)(b) amended, p. 1318, � 3, effective July 1. L. 2021: (1)(a) amended, (SB 21-271), ch. 462, p. 3240, � 478, effective March 1, 2022.
Cross references: For the legislative declaration contained in the 1994 act amending the introductory portion to subsection (1), see section 1 of chapter 345, Session Laws of Colorado 1994.
25-27-104. Minimum standards for assisted living residences - rules - definition. (1) On or before November 1, 2002, the state board shall promulgate rules pursuant to section 24-4-103, C.R.S., providing minimum standards for the location, sanitation, fire safety, adequacy of facilities, adequacy of diet and nutrition, equipment, structure, operation, provision of personal services and protective oversight, and personnel practices of assisted living residences within the state of Colorado. Such rules shall differentiate between homes of different sizes. In formulating such rules, the state board shall seek recommendations from the advisory committee established pursuant to section 25-27-110.
(2) State board rules promulgated pursuant to subsection (1) of this section must include, at a minimum, rules requiring the following:
(a) Compliance with all applicable zoning, housing, fire, sanitary, and other codes and ordinances of the city, city and county, or county where the residence is situated, to the extent that such codes and ordinances are consistent with the federal Fair Housing Amendments Act of 1988, as amended, 42 U.S.C. sec. 3601 et seq.;
(b) Annual inspection of assisted living residences by the department or its designated representative;
(c) That the premises to be used are in fit, safe, and sanitary condition and properly equipped to provide good care to the residents;
(d) That the Colorado long-term care ombudsman, designated by the department of human services, have access to the premises and residents during reasonable hours for the purposes set out in the federal Older Americans Act of 1965;
(e) Protection of the individual rights of residents either through a written board and care plan or by means of contracts executed with the residents, which board and care plan or contract shall meet the requirements stated in section 25-27-104.5;
(f) Responsibility of the assisted living residences for social supervision, personal services, and coordination with community resources as needed by the residents;
(g) That the administrator and staff of a residence:
(I) (A) Meet minimum educational, training, and experience standards established by the state board.
(B) On and after January 1, 2024, the state board's minimum standards for administrators must require, at a minimum, that each administrator, regardless of the administrator's hire date, have at least one year experience supervising the delivery of personal care services that includes activities of daily living or has attained the education or experience established by the state board in lieu of that supervisory experience.
(II) Are of good, moral, and responsible character. In making the determination, the owner or licensee of a residence shall have access to and shall obtain any criminal history record information from a criminal justice agency, subject to any restrictions imposed by the agency for any person responsible for the care and welfare of residents of the residence and shall obtain a check of the Colorado adult protective services data system pursuant to section 26-3.1-111 for any person who is an employee of the residence, as defined in section 26-3.1-111 (2), who will provide direct care to residents.
(h) Intermediate enforcement remedies as authorized by section 25-27-106 (2);
(i) Written plans, to be submitted by residences to the department for approval, detailing the measures that will be taken to correct violations found as a result of inspections;
(j) The definition for high medicaid utilization facility as a basis for a modified fee schedule. A high medicaid utilization residence shall be a residence in which no less than thirty-five percent of the available beds are occupied by medicaid enrollees as indicated by the most complete claims data available.
(k) A modified fee schedule for residences that serve a disproportionate share of low-income residents. The board may adopt a standard for determining residences that serve a disproportionate share of low-income residents. Such standard may require a residence to submit documentation determined appropriate by the department for verification.
(l) That the assisted living residence comply with the provisions of section 25-27-104.3 concerning the involuntary discharge of residents; and
(m) That the state board establish, not later than January 1, 2024, a range of fines for violations, which amounts may vary based on the size of the assisted living residence and the potential for harm to one or more persons, and shall permit the department to consider factors set forth in section 25-27-106 (4) in determining the amount of the fine. Prior to the board's adoption of rules concerning the range of fines for violations, the department shall make recommendations to the board, including a proposed schedule of fines that vary the range of fines by the severity and frequency of the violations and that may include a different range of fines based on the size of the residence. The department shall first present the recommendations to and seek feedback from the advisory committee established in section 25-27-110.
(3) (a) Rules adopted by the state board pursuant to subsection (1) of this section must exempt an assisted living residence from complying with the facility guideline institute (FGI) guidelines, except in the case of new construction or major renovations. An assisted living residence must still comply with all other fire and local building codes and the standards outlined in this section.
(b) As used in subsection (3)(a) of this section, major renovations means additions to a building's structure or changes that affect the structural integrity of the building. Major renovations do not include changing the functional operation of a space if no construction is completed and the floor plan of the building remains the same. It also does not include adding beds to accommodate more residents or upgrades to the heating or cooling systems and electrical systems if those improvements do not require construction.
Source: L. 84: Entire article added, p. 791, � 1, effective July 1. L. 85: Entire section R&RE, p. 925, � 4, effective July 1. L. 90: (2)(a) amended and (2)(g) added, p. 1355, � 3, effective July 1. L. 94: (2)(d) amended, p. 2703, � 259, effective July 1. L. 2002: (1), IP(2), (2)(a), (2)(b), (2)(f), and (2)(g) amended and (2)(h) to (2)(k) added, p. 1318, � 4, effective July 1. L. 2003: (2)(k) amended, p. 1998, � 47, effective May 22. L. 2006: (2)(e) amended, p. 254, � 2, effective January 1, 2007. L. 2022: IP(2) and (2)(g) amended and (2)(l) and (2)(m) added, (SB 22-154), ch. 323, p. 2287, � 2, effective June 2. L. 2025: (3) added, (HB 25-1213), ch. 276, p. 1434, � 2, effective August 6.
Cross references: For the legislative declaration contained in the 1994 act amending subsection (2)(d), see section 1 of chapter 345, Session Laws of Colorado 1994.
25-27-104.3. Involuntary discharge - notice - grievance process - appeal - hearing - rules - definition. (1) (a) (I) Except as provided in subsection (1)(c) of this section, an assisted living residence shall provide written notice of any involuntary discharge of a resident at least thirty calendar days in advance of the discharge to:
(A) The resident;
(B) The resident's legal representative; and
(C) Any relative or other person listed as a contact person for the resident or designated to receive notice of a discharge.
(II) Within five days after providing written notice to the resident, the residence shall send the discharge notice to the state long-term care ombudsman and the local ombudsman.
(b) (I) At a minimum, the notice of discharge must include a detailed explanation of the reason or reasons for the involuntary discharge, including:
(A) Facts and evidence supporting each reason given by the residence;
(B) A recounting of events leading to the involuntary discharge, including interactions with the resident over a period of time prior to the notice, and actions taken to avoid discharge and the timing of those actions;
(C) A statement that the resident or a person listed in subsection (1)(a)(I) of this section has the right to file a grievance with the residence challenging the involuntary discharge within fourteen days after the written notice, that the residence's designee must provide a response to the grievance within five business days after receiving the grievance, and, if the resident or person filing the grievance is dissatisfied with the response, that the resident or person filing the grievance may appeal to the executive director of the department or the executive director's designee pursuant to subsection (3) of this section; and
(D) Names and contact information, including telephone numbers, addresses, and email addresses, for the state long-term care ombudsman, the local ombudsman, and the department.
(II) If the residence's involuntary discharge of the resident is due to a medical or physical condition resulting in a required level of care that cannot be treated with medication or services routinely provided by the residence's staff or an external service provider, the notice must also include an assessment by the resident's physician or applicable health-care or behavioral health provider of the resident's current needs in relation to the resident's medical and physical condition.
(c) If the stated reason for the involuntary discharge is because the resident requires a level of care that cannot be met by the residence or the resident has demonstrated that the resident is a danger to the resident or others, thirty days' notice is not required. However, the residence shall give as much advance notice as is reasonable under the circumstances prior to the resident's removal from the residence. The residence must still provide written notice of the involuntary discharge pursuant to subsection (1)(b) of this section as soon as possible to the resident, other persons listed in subsection (1)(a)(I) of this section, and the state long-term care ombudsman and the local ombudsman. Notwithstanding the resident's removal from the residence pursuant to this subsection (1)(c), the resident may file a grievance relating to the involuntary discharge within fourteen days after the resident's receipt of the written notice of involuntary discharge required pursuant to subsection (1)(b) of this section.
(2) (a) (I) Each assisted living residence shall designate an individual to receive grievances, pursuant to subsection (2)(a)(II) of this section, relating to the involuntary discharge of a resident.
(II) A resident or any person listed in subsection (1)(a)(I) of this section may file a grievance with the designee within fourteen days after written notice is given to the resident pursuant to subsection (1)(b) or (1)(c) of this section challenging the involuntary discharge of the resident and the reasons for the discharge.
(III) A resident or a person listed in subsection (1)(a)(I) of this section filing a grievance shall submit the grievance in writing, cause it to be written, or state it orally to the designee, with the person filing the grievance providing some evidence of the oral submission of the grievance or a witness attesting to the oral submission.
(b) No later than five business days after a grievance has been submitted pursuant to subsection (2)(a) of this section, the designee shall provide a written response to the grievance to the resident, the persons listed in subsection (1)(a)(I) of this section, and the state long-term care ombudsman and the local ombudsman. The designee's written response must be accompanied by an oral explanation to the resident or person filing the grievance if appropriate because of the mental or physical condition of the resident or person filing the grievance.
(c) The state long-term care ombudsman or the local ombudsman may provide assistance to a resident or person filing a grievance in investigating, preparing, and filing the grievance pursuant to this subsection (2) or investigating, preparing, and filing an appeal of the designee's response to the grievance pursuant to subsection (3) of this section.
(3) If the resident or person filing the grievance is dissatisfied with the designee's written response, the resident or the person filing the grievance may appeal to the department for review of the designee's response to the grievance by filing the same grievance, the original notice and supporting documentation given to the resident pursuant to subsection (1)(b) or (1)(c) of this section, and the designee's written response pursuant to subsection (2)(b) of this section, including supporting documentation, along with any additional information or documentation, to the executive director of the department for the department's review. An appeal to the executive director of the department must be filed within five business days after the resident or person filing the grievance receives the designee's written response. The department shall review the grievance and response as soon as possible, but no later than sixty days after receiving the appeal, to determine whether the involuntary discharge complies with the law and the process established in this section. The department may confer with or receive information from the resident, the residence, and the state long-term care ombudsman and the local ombudsman concerning the involuntary discharge.
(4) (a) The assisted living residence shall not take any punitive or retaliatory action against a resident due to the resident filing a grievance or appeal pursuant to this section and shall continue to assist with planning a discharge or transfer of the resident while the grievance or appeal to the department is pending.
(b) If the stated reason for the involuntary discharge is for nonpayment of monthly services or room and board, the residence may discharge the resident on the thirty-first day after the written notice of discharge has been provided to the resident. If it is determined through the grievance and appeal process that the resident substantially complied with payments due to the residence, the residence shall allow the resident to return to the residence.
(5) If the resident, the person filing the grievance or the appeal, or the assisted living residence is dissatisfied with the findings and recommendations of the department, that resident, person, or residence may request a hearing conducted by the department pursuant to section 24-4-105.
(6) (a) No later than January 1, 2024, the state board shall promulgate rules necessary to implement the grievance process set forth in this section.
(b) Prior to the board's adoption of rules for the implementation of the grievance process, the department shall confer with the advisory committee established in section 25-27-110 for the purpose of making recommendations to the board concerning rules relating to the grievance process.
(7) As used in this section, designee means the individual designated by the assisted living residence to receive grievances relating to an involuntary discharge of a resident pursuant to subsection (2)(a)(I) of this section.
Source: L. 2022: Entire section added, (SB 22-154), ch. 323, p. 2284, � 1, effective June 2.
25-27-104.5. Requirements governing forfeiture of security deposits and rent. If a lease provision in a resident care plan or in a contract signed by a resident of an assisted living residence results in or requires forfeiture of more than thirty days of rent if a resident moves due to a medical condition or dies during the term of the plan, then the plan shall be deemed to be against public policy and shall be void; except that inclusion of such a provision shall not render the remainder of the plan or contract void. A lease provision in a written board and care plan or in a contract that requires forfeiture of rent for thirty days after the resident moves due to a medical condition or dies does not violate this section. The provisions regarding forfeiture of rent shall appear on the front page of the plan or contract and shall be printed in no less than twelve-point bold-faced type. The provisions shall read as follows:
This lease agreement is for a month-to-month tenancy. The lessor shall not require the forfeiture of rent beyond a thirty-day period if the lessee moves due to a medical condition or dies during the term of the lease.
In circumstances in which the resident moves due to a medical condition or dies during the term of a plan or contract, the assisted living residence shall return that part of rent paid in excess of thirty days' rent after a patient moves or dies to the resident or the resident's estate. The assisted living residence may assess daily rental charges for any days in which the former or deceased resident's personal possessions remain in the resident's room after the time period for which the resident has paid rent and for the usual time to clean the room after the resident's personal possessions have been removed. For purposes of this section, daily rental charges means an amount not to exceed one-thirtieth of thirty days' rental amount plus reasonable expenses.
Source: L. 2006: Entire section added, p. 254, � 3, effective January 1, 2007.